|
BCE VL Upper Extremity PVR w Resting
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3114984
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$825.97 |
| Rate for Payer: Aetna Commercial |
$825.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$747.72
|
| Rate for Payer: Aetna Managed Medicare |
$70.76
|
| Rate for Payer: Anthem Medicare Advantage |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.76
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$825.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.76
|
| Rate for Payer: Health EOS Commercial |
$791.19
|
| Rate for Payer: HFN Commercial |
$825.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.76
|
| Rate for Payer: Multiplan Commercial |
$695.55
|
| Rate for Payer: NAPHCARE Commercial |
$106.14
|
| Rate for Payer: Preferred Network Access Commercial |
$825.97
|
| Rate for Payer: Quartz Beloit One Network |
$382.55
|
| Rate for Payer: Quartz Commercial |
$495.58
|
| Rate for Payer: Quartz Medicare Advantage |
$70.76
|
| Rate for Payer: The Alliance Commercial |
$176.90
|
| Rate for Payer: United Healthcare Medicaid |
$71.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.76
|
| Rate for Payer: WEA Trust Commercial |
$478.19
|
| Rate for Payer: WPS Commercial |
$283.05
|
|
|
BCE VL Vascular Access Guidance
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
4052743
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$227.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Aetna Managed Medicare |
$70.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$164.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$126.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.94
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.43
|
| Rate for Payer: Health EOS Commercial |
$224.92
|
| Rate for Payer: HFN Commercial |
$232.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189.54
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: NAPHCARE Commercial |
$151.63
|
| Rate for Payer: Preferred Network Access Commercial |
$232.50
|
| Rate for Payer: Quartz Beloit One Network |
$123.83
|
| Rate for Payer: Quartz Commercial |
$164.27
|
| Rate for Payer: Quartz Medicare Advantage |
$151.63
|
| Rate for Payer: The Alliance Commercial |
$105.58
|
| Rate for Payer: United Healthcare PPO |
$189.54
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: WPS Commercial |
$187.18
|
|
|
BCE VL Vascular Access Guidance
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
4052743
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$240.08 |
| Rate for Payer: Aetna Commercial |
$240.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Aetna Managed Medicare |
$26.40
|
| Rate for Payer: Anthem Medicare Advantage |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.40
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$240.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.40
|
| Rate for Payer: Health EOS Commercial |
$229.98
|
| Rate for Payer: HFN Commercial |
$240.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: NAPHCARE Commercial |
$39.59
|
| Rate for Payer: Preferred Network Access Commercial |
$240.08
|
| Rate for Payer: Quartz Beloit One Network |
$111.20
|
| Rate for Payer: Quartz Commercial |
$144.05
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$100.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: WPS Commercial |
$131.98
|
|
|
BCE VL Vascular Access Guidance
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
4052743
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$123.83 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$227.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.94
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: Health EOS Commercial |
$224.92
|
| Rate for Payer: HFN Commercial |
$232.50
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: Preferred Network Access Commercial |
$232.50
|
| Rate for Payer: Quartz Beloit One Network |
$123.83
|
| Rate for Payer: Quartz Commercial |
$151.63
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: WPS Commercial |
$187.18
|
|
|
BCE VL Vascular Guidance Intraop
|
Facility
|
OP
|
$1,955.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
3114985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$105.58 |
| Max. Negotiated Rate |
$1,870.54 |
| Rate for Payer: Aetna Commercial |
$1,829.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,748.55
|
| Rate for Payer: Aetna Managed Medicare |
$569.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,321.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,016.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$975.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.60
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,870.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,137.81
|
| Rate for Payer: Health EOS Commercial |
$1,809.55
|
| Rate for Payer: HFN Commercial |
$1,870.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,524.90
|
| Rate for Payer: Multiplan Commercial |
$1,626.56
|
| Rate for Payer: NAPHCARE Commercial |
$1,219.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,870.54
|
| Rate for Payer: Quartz Beloit One Network |
$996.27
|
| Rate for Payer: Quartz Commercial |
$1,321.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,219.92
|
| Rate for Payer: The Alliance Commercial |
$105.58
|
| Rate for Payer: United Healthcare PPO |
$1,524.90
|
| Rate for Payer: WEA Trust Commercial |
$1,118.26
|
| Rate for Payer: WPS Commercial |
$1,505.94
|
|
|
BCE VL Vascular Guidance Intraop
|
Professional
|
Both
|
$1,955.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
3114985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$1,931.54 |
| Rate for Payer: Aetna Commercial |
$1,931.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,748.55
|
| Rate for Payer: Aetna Managed Medicare |
$26.40
|
| Rate for Payer: Anthem Medicare Advantage |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.40
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,931.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,016.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.40
|
| Rate for Payer: Health EOS Commercial |
$1,850.21
|
| Rate for Payer: HFN Commercial |
$1,931.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$1,626.56
|
| Rate for Payer: NAPHCARE Commercial |
$39.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,931.54
|
| Rate for Payer: Quartz Beloit One Network |
$894.61
|
| Rate for Payer: Quartz Commercial |
$1,158.92
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$100.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$1,118.26
|
| Rate for Payer: WPS Commercial |
$131.98
|
|
|
BCE VL Vascular Guidance Intraop
|
Facility
|
IP
|
$1,955.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
3114985
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$996.27 |
| Max. Negotiated Rate |
$1,870.54 |
| Rate for Payer: Aetna Commercial |
$1,829.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,748.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.60
|
| Rate for Payer: Cash Price |
$586.50
|
| Rate for Payer: Cigna Commercial |
$1,870.54
|
| Rate for Payer: Health EOS Commercial |
$1,809.55
|
| Rate for Payer: HFN Commercial |
$1,870.54
|
| Rate for Payer: Multiplan Commercial |
$1,626.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,870.54
|
| Rate for Payer: Quartz Beloit One Network |
$996.27
|
| Rate for Payer: Quartz Commercial |
$1,219.92
|
| Rate for Payer: WEA Trust Commercial |
$1,118.26
|
| Rate for Payer: WPS Commercial |
$1,505.94
|
|
|
BCE VL Vasoreactivity Testing
|
Facility
|
OP
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
3114986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$575.12 |
| Max. Negotiated Rate |
$1,889.68 |
| Rate for Payer: Aetna Commercial |
$1,848.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Aetna Managed Medicare |
$575.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,335.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,027.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$985.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,088.62
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,889.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,149.45
|
| Rate for Payer: Health EOS Commercial |
$1,828.06
|
| Rate for Payer: HFN Commercial |
$1,889.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,540.50
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,232.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,889.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.46
|
| Rate for Payer: Quartz Commercial |
$1,335.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,232.40
|
| Rate for Payer: The Alliance Commercial |
$1,027.00
|
| Rate for Payer: United Healthcare PPO |
$1,540.50
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
BCE VL Vasoreactivity Testing
|
Professional
|
Both
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
3114986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$828.11 |
| Max. Negotiated Rate |
$1,951.30 |
| Rate for Payer: Aetna Commercial |
$1,951.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,951.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,027.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.40
|
| Rate for Payer: Health EOS Commercial |
$1,869.14
|
| Rate for Payer: HFN Commercial |
$1,951.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$828.11
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.30
|
| Rate for Payer: Quartz Beloit One Network |
$903.76
|
| Rate for Payer: Quartz Commercial |
$1,170.78
|
| Rate for Payer: The Alliance Commercial |
$1,027.00
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
BCE VL Vasoreactivity Testing
|
Facility
|
IP
|
$1,975.00
|
|
|
Service Code
|
CPT 93890 TC
|
| Hospital Charge Code |
3114986
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,006.46 |
| Max. Negotiated Rate |
$1,889.68 |
| Rate for Payer: Aetna Commercial |
$1,848.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,766.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,088.62
|
| Rate for Payer: Cash Price |
$592.50
|
| Rate for Payer: Cigna Commercial |
$1,889.68
|
| Rate for Payer: Health EOS Commercial |
$1,828.06
|
| Rate for Payer: HFN Commercial |
$1,889.68
|
| Rate for Payer: Multiplan Commercial |
$1,643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,889.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.46
|
| Rate for Payer: Quartz Commercial |
$1,232.40
|
| Rate for Payer: WEA Trust Commercial |
$1,129.70
|
| Rate for Payer: WPS Commercial |
$1,521.34
|
|
|
BCE VL Vein Mapping Bilateral
|
Professional
|
Both
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114987
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$2,443.32 |
| Rate for Payer: Aetna Commercial |
$2,443.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.85
|
| Rate for Payer: Aetna Managed Medicare |
$95.06
|
| Rate for Payer: Anthem Medicare Advantage |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.06
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,443.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.06
|
| Rate for Payer: Health EOS Commercial |
$2,340.45
|
| Rate for Payer: HFN Commercial |
$2,443.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.06
|
| Rate for Payer: Multiplan Commercial |
$2,057.54
|
| Rate for Payer: NAPHCARE Commercial |
$142.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,443.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,131.64
|
| Rate for Payer: Quartz Commercial |
$1,465.99
|
| Rate for Payer: Quartz Medicare Advantage |
$95.06
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare Medicaid |
$90.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.06
|
| Rate for Payer: WEA Trust Commercial |
$1,414.56
|
| Rate for Payer: WPS Commercial |
$380.22
|
|
|
BCE VL Vein Mapping Bilateral
|
Facility
|
IP
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114987
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$1,260.24 |
| Max. Negotiated Rate |
$2,366.17 |
| Rate for Payer: Aetna Commercial |
$2,314.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,363.12
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,366.17
|
| Rate for Payer: Health EOS Commercial |
$2,289.01
|
| Rate for Payer: HFN Commercial |
$2,366.17
|
| Rate for Payer: Multiplan Commercial |
$2,057.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,366.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,260.24
|
| Rate for Payer: Quartz Commercial |
$1,543.15
|
| Rate for Payer: WEA Trust Commercial |
$1,414.56
|
| Rate for Payer: WPS Commercial |
$1,904.95
|
|
|
BCE VL Vein Mapping Bilateral
|
Facility
|
OP
|
$2,473.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114987
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$380.22 |
| Max. Negotiated Rate |
$2,366.17 |
| Rate for Payer: Aetna Commercial |
$2,314.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,211.85
|
| Rate for Payer: Aetna Managed Medicare |
$720.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,671.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,285.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,234.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,363.12
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cash Price |
$741.90
|
| Rate for Payer: Cigna Commercial |
$2,366.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,439.29
|
| Rate for Payer: Health EOS Commercial |
$2,289.01
|
| Rate for Payer: HFN Commercial |
$2,366.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,928.94
|
| Rate for Payer: Multiplan Commercial |
$2,057.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,543.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,366.17
|
| Rate for Payer: Quartz Beloit One Network |
$1,260.24
|
| Rate for Payer: Quartz Commercial |
$1,671.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,543.15
|
| Rate for Payer: The Alliance Commercial |
$380.22
|
| Rate for Payer: United Healthcare PPO |
$1,928.94
|
| Rate for Payer: WEA Trust Commercial |
$1,414.56
|
| Rate for Payer: WPS Commercial |
$1,904.95
|
|
|
BCE VL Vein Mapping Unilateral
|
Facility
|
IP
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114988
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$731.28 |
| Max. Negotiated Rate |
$1,373.01 |
| Rate for Payer: Aetna Commercial |
$1,343.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$790.97
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,373.01
|
| Rate for Payer: Health EOS Commercial |
$1,328.24
|
| Rate for Payer: HFN Commercial |
$1,373.01
|
| Rate for Payer: Multiplan Commercial |
$1,193.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.01
|
| Rate for Payer: Quartz Beloit One Network |
$731.28
|
| Rate for Payer: Quartz Commercial |
$895.44
|
| Rate for Payer: WEA Trust Commercial |
$820.82
|
| Rate for Payer: WPS Commercial |
$1,105.38
|
|
|
BCE VL Vein Mapping Unilateral
|
Professional
|
Both
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114988
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$90.17 |
| Max. Negotiated Rate |
$1,417.78 |
| Rate for Payer: Aetna Commercial |
$1,417.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.46
|
| Rate for Payer: Aetna Managed Medicare |
$95.06
|
| Rate for Payer: Anthem Medicare Advantage |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.06
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,417.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.06
|
| Rate for Payer: Health EOS Commercial |
$1,358.08
|
| Rate for Payer: HFN Commercial |
$1,417.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$358.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$358.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.06
|
| Rate for Payer: Multiplan Commercial |
$1,193.92
|
| Rate for Payer: NAPHCARE Commercial |
$142.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.78
|
| Rate for Payer: Quartz Beloit One Network |
$656.66
|
| Rate for Payer: Quartz Commercial |
$850.67
|
| Rate for Payer: Quartz Medicare Advantage |
$95.06
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare Medicaid |
$90.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.06
|
| Rate for Payer: WEA Trust Commercial |
$820.82
|
| Rate for Payer: WPS Commercial |
$380.22
|
|
|
BCE VL Vein Mapping Unilateral
|
Facility
|
OP
|
$1,435.00
|
|
|
Service Code
|
CPT 93971 TC
|
| Hospital Charge Code |
3114988
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$380.22 |
| Max. Negotiated Rate |
$1,373.01 |
| Rate for Payer: Aetna Commercial |
$1,343.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.46
|
| Rate for Payer: Aetna Managed Medicare |
$417.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$790.97
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cash Price |
$430.50
|
| Rate for Payer: Cigna Commercial |
$1,373.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$835.17
|
| Rate for Payer: Health EOS Commercial |
$1,328.24
|
| Rate for Payer: HFN Commercial |
$1,373.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,119.30
|
| Rate for Payer: Multiplan Commercial |
$1,193.92
|
| Rate for Payer: NAPHCARE Commercial |
$895.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.01
|
| Rate for Payer: Quartz Beloit One Network |
$731.28
|
| Rate for Payer: Quartz Commercial |
$970.06
|
| Rate for Payer: Quartz Medicare Advantage |
$895.44
|
| Rate for Payer: The Alliance Commercial |
$380.22
|
| Rate for Payer: United Healthcare PPO |
$1,119.30
|
| Rate for Payer: WEA Trust Commercial |
$820.82
|
| Rate for Payer: WPS Commercial |
$1,105.38
|
|
|
BCE XR Abdomen AP
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
3091480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.95 |
| Max. Negotiated Rate |
$508.06 |
| Rate for Payer: Aetna Commercial |
$497.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Aetna Managed Medicare |
$154.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.69
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$508.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.04
|
| Rate for Payer: Health EOS Commercial |
$491.49
|
| Rate for Payer: HFN Commercial |
$508.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.18
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: NAPHCARE Commercial |
$331.34
|
| Rate for Payer: Preferred Network Access Commercial |
$508.06
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$358.96
|
| Rate for Payer: Quartz Medicare Advantage |
$331.34
|
| Rate for Payer: The Alliance Commercial |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
BCE XR Abdomen AP
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
3091480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$508.06 |
| Rate for Payer: Aetna Commercial |
$497.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.69
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$508.06
|
| Rate for Payer: Health EOS Commercial |
$491.49
|
| Rate for Payer: HFN Commercial |
$508.06
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: Preferred Network Access Commercial |
$508.06
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$331.34
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
BCE XR Abdomen AP
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 74018 TC
|
| Hospital Charge Code |
3091480
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.74 |
| Max. Negotiated Rate |
$524.63 |
| Rate for Payer: Aetna Commercial |
$524.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Aetna Managed Medicare |
$20.74
|
| Rate for Payer: Anthem Medicare Advantage |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.74
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$524.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$276.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.74
|
| Rate for Payer: Health EOS Commercial |
$502.54
|
| Rate for Payer: HFN Commercial |
$524.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.74
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: NAPHCARE Commercial |
$31.11
|
| Rate for Payer: Preferred Network Access Commercial |
$524.63
|
| Rate for Payer: Quartz Beloit One Network |
$242.99
|
| Rate for Payer: Quartz Commercial |
$314.78
|
| Rate for Payer: Quartz Medicare Advantage |
$20.74
|
| Rate for Payer: The Alliance Commercial |
$78.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.74
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$103.69
|
|
|
BCE XR Ankle 2 Views Left
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 73600 TC,LT
|
| Hospital Charge Code |
3925477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Aetna Managed Medicare |
$145.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.42
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.22
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: NAPHCARE Commercial |
$311.38
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$337.32
|
| Rate for Payer: Quartz Medicare Advantage |
$311.38
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
BCE XR Ankle 2 Views Left
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 73600 TC,LT
|
| Hospital Charge Code |
3925477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$493.01 |
| Rate for Payer: Aetna Commercial |
$493.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$493.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.38
|
| Rate for Payer: Health EOS Commercial |
$472.25
|
| Rate for Payer: HFN Commercial |
$493.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$493.01
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$295.81
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
BCE XR Ankle 2 Views Left
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 73600 TC,LT
|
| Hospital Charge Code |
3925477
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$254.29 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$311.38
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
BCE XR Ankle Complete Left
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,LT
|
| Hospital Charge Code |
3091463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.71 |
| Max. Negotiated Rate |
$549.33 |
| Rate for Payer: Aetna Commercial |
$549.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$549.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.94
|
| Rate for Payer: Health EOS Commercial |
$526.20
|
| Rate for Payer: HFN Commercial |
$549.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.71
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$549.33
|
| Rate for Payer: Quartz Beloit One Network |
$254.43
|
| Rate for Payer: Quartz Commercial |
$329.60
|
| Rate for Payer: The Alliance Commercial |
$289.12
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
BCE XR Ankle Complete Left
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,LT
|
| Hospital Charge Code |
3091463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.91 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$161.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.68
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$346.94
|
| Rate for Payer: The Alliance Commercial |
$289.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
BCE XR Ankle Complete Left
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 73610 TC,LT
|
| Hospital Charge Code |
3091463
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
